| NPI | 1699265413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101028726) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 288291) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2025-07-31 |